Dr. Theresa Williamson has led a rewarding career as a neurosurgeon at Duke Health. And as a graduate of Yale University School of Medicine, her skill and dedication were instantly recognized by professional societies and colleagues in the early stages of her career, propelling such awards as the National Neurotrauma Spinal Presentation Award and the Duke Neurosurgery Clinician Award. 

Her passion and commitment has led her to write for publications like Oprah Magazine, and, most recently, to the recent launch of a new health & wellness app, THX Rx, previously WellSpentMD. THX Rx uses positive news, a time-banking program, access to wellness resources, and wellness data collection to boost positivity in the workplace and address physician burnout. 

We chatted with Dr. Williamson to learn more about her app and her experience working with Oak City Labs to bring it to market.  

Oak City Labs: What’s your backstory and the inspiration behind THX Rx? 

Theresa Williamson: I’m a neurosurgery resident at the Department of Neurosurgery at Duke Health. With the high rates of physician burnout among U.S. health professionals, the subject hits close to home. So, I wanted to learn more about the causes and also what physicians have found works best for them when it comes to overcoming it.

One of the biggest things we heard was “reward”. Not in the sense of physical or tangible rewards, but hearing from people that they did a great job, or went the extra mile as a physician. We also learned that providers gain reward and happiness from charting. 

We looked at people’s productivity and their ability to do a good job and take care of patients. We wanted to preserve and encourage that. Plus, we wanted to build a community for physicians so they can connect with each other.

This is a career that I love, and I wanted to encourage the people around me to be happy as well. 

OCL: What was the process like for finding software development help? 

TW: When it came to building the app, we started at an institutional level and looked around Duke to be cost conscious.

We met with three developers, and went to a few forums where they had different people present, and we talked to them and got quotes. We came across Oak City Labs a little later on from a mentor who was helping us develop our idea. He said he really liked Oak City Labs, and they tend to be really fair, so we may get overall what we want for a better price.

OCL: Did you run into any obstacles? 

TW: We’re not tech experts – my expertise is in neurosurgery. So, it was hard for me to evaluate the contracts and not feel like, some of the time, we’re being kinda ripped off. There were tens of thousands of dollars of difference between the quotes, which was a real challenge.

Software development is really expensive. But, you’re looking at it and thinking, I can’t personally do that work, but I’m also not sure that this is right.

Also, within an academic institution and hospital, we had to make sure we were able to get a software development team that could comply with regulations. Even though we wanted to use Oak City Labs, we still had to go through a process to make sure everything was okay for their team to implement our app within their system. 

OCL: Could you tell me more about your experience working with Oak City Labs?

TW: From a professional interaction, we needed flexibility. Because of our work schedules, we can’t meet in the middle of the day, so we needed to do our check in calls at night.

We also wanted a team who could incorporate our ideas, but be willing to say, no, we think this is the way people use things, or they may really dislike that feature. So, that really honest rapport was important to us.

I really liked their ability to say directly, this is what we’ll do, this is what you’ll deliver on, and this is the timeline. Also, I appreciated their process of having quick phone calls that don’t waste your time. They very clearly laid out what they were thinking. 

I felt there was nothing left to question. There was no thinking, ‘Oh, two months from now, I’m going to want this feature, and they’re going to say, no way’.

They were honest, very diligent, and meticulous with setting up the project. And keeping us on the timeline as well, which I found really helpful. 

The transparency and the work they put into the proposal to make sure it was something everyone would be happy with made it really easy to trust them. 

They also took the complexity of the development process and made it approachable for people who are not in the tech space, like us.

Oak City Labs forced us to put work in the app so we would love it. They have that insight and interest that they’ll make something people will be able to use. And the long term vision to keep their customer and not just develop something once. Now, we’re working with them again a few years later. 

OCL: How does it feel knowing you’re making a positive impact in your industry? 

TW: The app is super exciting and really cool. Our department was really excited about it.

The best part was trying to develop something people will love, and then seeing that happen. We pulled in a lot of people in the process of testing it out, so it was a really exciting moment to see people use it.

We now have lots of different hospitals interested in incorporating it. We’ve been able to create a new way of getting wellness data from physicians. And the biggest success has been that now the entire Duke hospital system will be taking on the app this summer.

Luke Marshall is all too familiar with inventions that improve lives and usher in a new future. He studied under John B. Goodenough, who invented the lithium-ion battery, while he was working towards his Ph.D. of Materials Science and Engineering at the University of Texas at Austin. 

With an interest in getting core scientific technologies off the bench and into the real world, he helped set up commercialization partnerships with an S&P 500 company to get more familiar with technology transfer (the process of transferring technology from one person or organization to another). 

Attracted by research at North Carolina State University, Marshall founded VitalFlo to pull technology out of the university and bring it to market. VitalFlo is a remote patient monitoring system for asthma management, designed to prevent asthma attacks before they happen.

As VitalFlo’s technology is becoming increasingly pivotal to healthcare workers amid COVID-19, our marketing team conducted a Q&A with Marshall to learn more about his journey as a tech entrepreneur and the process of building new digital health solutions.

Oak City Labs: Tell me about your background, and what motivated you to start VitalFlo? 

Luke Marshall: My background is in different technical fields, but I got really involved with technology transfer. I was looking at what patents and intellectual property universities have developed that are stuck in research land. How do you get them off the bench and out into the real world with a product that makes an impact?

VitalFlo was one that kind of popped off the shelf, so to speak. It was this great tech that had a lot of progress already done, and there was a need for it in the market. So, I came in to help pull it out from the university and spin it forward. 

The idea for the technology came from our clinical advisors who are experts in asthma care. They wanted a way to connect with their patients at home to see what’s going on outside the four walls of the hospital or the clinic where most of their patients live their lives. 

We started as a project at NC State University, collaborating with the University of North Carolina. In the beginning, I tried to shepherd it along with limited resources, with a technical but not software-oriented team, which we have since built.

OCL: How does VitalFlo work, and what drew you to this technology?  

LM: We, Vitaflo as a company, help doctors keep their asthma patients out of the ER. We do that through a remote monitoring solution. It’s a mobile app that a patient uses in their home that connects to a few different devices that monitor their health and environment. We pull that back to the clinical team and, using advanced analytics, help forecast patient health. 

In a world where there’s 25 million asthmatics, 13 million people with COPD in the U.S. alone, and 10 people die every day from asthma attacks in the U.S.; it’s very easy to wake up in the morning and work hard every day trying to find a solution. We wanted to help forecast when a patient is at risk, so their doctors can make a preventative treatment for their industry.


OCL: Tell me about building this technology. What did you learn that you could share with other startups?

LM: We had some individual contributors and contractors that we worked with right out of the commercialization process. But, it’s tricky to work with individuals because their circumstances can change. Hiring part-time, you don’t get to really control your destiny with that individual because they’re going to be looking for other projects or companies to join that can support them full-time. And, in the early days, we just weren’t in the position to support that.

After we had moved through our second part-time developer, we realized a more stable solution would be to work with a development house where we could flex that resource up and down based on where we are in the cycle. A development house also has the advantage of you getting multiple people with multiple different types of expertise for one engagement.

For example, when we were working on the patient-facing app, we needed someone who had iOS and Android experience. When we were working with developing the backend, we really needed somebody with Cloud, SQLl, and API development expertise. Usually, those are different people, and you get better quality work if you work with people who specialize.
While we still weren’t ready for an in-house development team, we did need to scale up the product. That’s when we started looking around and met Oak City Labs through our network.

We had a couple of firms in the region we were looking at. The big deciding point was some of the firms had a local presence, usually the sales folks, but they had offshore development teams. While the advantage of that is it’s less expensive, the disadvantage is you’re working on different time cycles. The communication is more challenging, just in terms of keeping everyone on the same page and moving quickly. 

There can also be a difference in quality, depending on who you’re working with. And when you’re a company that does not have very many resources, where you spend those resources matters quite a bit. Spending them in the wrong place can be the difference between making it through the phase when you’re building out the product, but you’re not selling as much.  

The thing that really attracted us to Oak City Labs was the high recommendations we got from trusted friends and peers in the network that we didn’t need to worry about the quality of work. And that the founders had startup experience in their back pocket.

They had an intuition and understanding of the different cycles we were going to go through as a company. Oak City Labs understood that our plan was to grow quickly and was able to work with us knowing our priorities could change rapidly from one week to the next. It was attractive to work with a team that could have that empathy with us. 

OCL: What else could you share about your partnership with Oak City Labs?

LM: Everything has been pretty easy. I’ve really enjoyed working with them.

As we’ve grown, we’ve also brought in our own internal developers, and the transition from having a fully outsourced development team to a split development team has been smooth.

I could see that causing issues with other firms, potentially, because it’s either a threat to business or an opportunity to collaborate.

The experience that we have is a new collaboration and one that has continued to evolve as we go. But even as we grow our internal team, we have no plans to move away from Oak City Labs because they’ve been great to work with, and they’re such a flexible, high-quality resource. 

I really like how transparent and easy it is to work with Oak City Labs. We always know where we stand week-to-week. If we’re in one of those periods where everything is smooth, and we can handle everything internally on our end, we can just kick the can a week or two, and that’s not a big deal. They aren’t overly aggressive, trying to create work where there isn’t any to be done. 

It’s just been very easy to flex up and down and use the resources they offer, tactically and strategically. We’ve been very happy with the quality all along the way, which is why we continue to move forward with Oak City Labs. 

OCL: How do you feel now that VitalFlo is out to market? 

LM: It’s been great, and sort of ever-evolving.

There’s not really an end date for development. We keep coming up with new features that make sense to add based on what we’re getting back from our customers. We keep that process moving, so it’s very much an agile process where we’re coming up with the next features and next iterations as we go. And it’s easy to keep adding those along the way. 

Right now, we’re doing a full redesign. Before working with Oak City Labs, the app was doing way too much heavy lifting. Most of the functionality that should live in a good system architecture on the cloud, we had a lot of it on the app, so it was bulky and inelegant.

Oak City Labs helped us incorporate it into the cloud infrastructure to make the system more scalable as we started to add more customers and go live with our clinical studies.

Now that the cloud base is where we want it, we’re doing the next evolution of the patient-facing side.

OCL: How does it feel knowing you’re making an impact through your technology? 

LM: It’s just a very cool space to be in. There are a lot of challenges with it: in terms of making sure things are doing well on a regulatory side and keeping all your boxes checked. You also have to make sure everything is high-quality, and you’re taking care of your patients and making sure your data is safe and secure. But, it’s very rewarding to be making a difference, hopefully.

As we grow, we hope to be able to make more and more of a difference over time as well. It’s been a lot of fun. 

Stuart Bradley is the founder and CEO of not one, but two companies – Carolina Speech Pathology LLC and Altaravision. We caught up with him on a busy Monday afternoon in between meetings, and he was gracious enough to take some time to talk with us about his experience as founder of Altaravision and the interesting journey of their flagship product, NDŌʜᴅ.

Put simply, NDŌʜᴅ is the most portable, high-definition endoscopic imaging system on the market today and an invaluable tool for speech pathologists. It has been extremely well received by the medical community, but its path from concept to market was not without its obstacles.

Where did the idea for NDŌʜᴅ come from? Because it is a very specific product.

It came from a need. Specifically, the need to be able to do machine vision on a Macintosh. Surprisingly, there really wasn’t any software that addressed it anywhere in the marketplace.

Would you mind just briefly explaining what machine vision is?

Sure. Machine vision is the ability for a computer to view imagery or an object, take that information and then display it. Essentially, it is a computer’s ability to see.

And the capacity to do that wasn’t on a Mac? That’s interesting.

Well, no. There was plenty of software out there, but it was all secondary purpose. The bigger issue was that nothing had the capabilities you would need in a medical setting.

It all comes down to video capture. All of the off-the-shelf software could capture images, but they suffered from significant lag. What you saw on the screen might be a full second behind what was happening in real time. That might not seem like much, but when you are dealing with medical procedures that kind of lag isn’t going to cut it.

I played around with off-the-shelf software for a number of years and finally found something I thought might work, but there were a ton of features that I didn’t want or need. I reached out to the developer to make me a one-off, but he was ultimately unable to deliver a final product. That’s what led me to Oak City Labs.

Once you had your software developer in Oak City Labs, what was the hardest part about going from this idea you had to an actual finished product?

By far, the biggest hurdle was doing it in a way that maintains compliance with FDA regulations. Jay Lyerly, the one who was doing the coding, knew that from the start and was able to work with my FDA consultant in a way that we could survive an FDA audit.

The thing is, FDA audits are worse than IRS audits and you’re guaranteed to get one, whereas IRS audits are random. As a medical device company, we are audited every two years by the FDA. Thanks to Jay and Carol at OCL, we’ve been able to pass every single audit with zero deficiencies, which is nearly unheard of.

Was there a moment when you got NDŌʜᴅ out into the world and thought “ok, we did it.”

Yea, there was. With FDA-regulated software you actually do have to draw that line in the sand. Unlike other software development cycles, where updates are always being pushed out, you can’t do that with medical devices. It has to be the finished product from the day it comes out. If you add features, it has to go back through the FDA approval process, which, as you can imagine, is pretty lengthy.

If you could do it all over again, is there anything that you’d do differently?

We bootstrapped the entire thing, with CNP essentially acting like an angel investor for the product. That was really tough, especially when there are people out there actively looking for good products to invest in. If I had to do it again, I would have taken the time to seek out some outside investment instead of just jumping in and doing it all myself.

When you think about where you are today as a business owner, is there anything that sticks out to you as the thing you are most proud of?

Honestly, being able to take on, create, sell and make an actual viable business out of a medical device when I had no prior experience in that industry. I had owned Carolina Speech Pathology for years, but the journey with Altaravision and NDŌʜᴅ was an entirely new one.

What’s your favorite part about doing what you do?

It has to be the satisfaction I get from solving hard problems, and the fact that it’s never boring.

Finally, whenever you have clients or colleagues that are talking about Altaravision or the NDŌʜᴅ product, what do you want them to say or know about it?

I want them to know two things. First, I want them to know it works, and always works. Second, that it is designed to be incredibly easy to use. If you can use Facebook, you can use NDŌʜᴅ.

For more on Oak City Lab’s work with Stuart Bradley and Altavision, check out this article Jay wrote on Computer Vision for Medical Devices via Core Image. If you have an idea and need a software development partner, or if you just have some questions about the development process, we’d love to talk to you. Follow the link below to contact us!